Nonunion refers to a condition in which a broken bone fails to heal properly, even after the normal healing period has passed following a fracture.
Normally, a fracture heals within several months with appropriate treatment. However, if nonunion occurs, the bone remains unhealed, causing persistent pain and impaired function.
Causes of Nonunion
Inadequate Fixation
When the fracture site is not properly or stably fixed
Poor Blood Supply
Insufficient blood flow to the bone, which is essential for healing
Infection
Infection at the fracture site interfering with the healing process
Severe Bone Damage
Extensive injuries such as comminuted or open fractures
Systemic Conditions
Conditions that hinder bone healing, including diabetes, osteoporosis, smoking, or malnutrition
Excessive Movement
Overuse of the fracture site during treatment, disrupting healing
Symptoms of Nonunion
Persistent Pain
Pain at the fracture site lasting for several months or more
Swelling and Tenderness
Continued swelling or pain when pressing on the area
Deformity
Abnormal shape or alignment at the fracture site
Limited Mobility
Reduced joint mobility and function in the affected area
Abnormal Movement
A loose or unstable feeling, as the bone remains unjoined
Instability During Activity
A feeling of instability when applying force or bearing weight
Diagnosis of Nonunion
Accurately identifying the cause is critical for establishing the right treatment plan, including whether reoperation is necessary.
Physical Examination
Assessment of pain, deformity, and mobility
X-Ray
Persistent fracture line and lack of bone healing
CT Scan
Detailed view of the fracture structure and extent of nonunion
MRI
Evaluation of blood flow, soft tissue damage, or possible infection
Blood Tests
To determine presence of infection or systemic disease
Treatment for Nonunion
If pain and instability persist after fracture surgery,
reoperation may be required.
Internal Fixation
Stabilization using metal plates, screws, or pins
Bone Graft
Grafting autologous (self) or artificial bone to stimulate healing
External Fixation
Stable fixation using an external device
Concurrent Infection Treatment
In cases of infectious nonunion, antibiotics are administered alongside surgery
Precautions
Although rare, bleeding, infection, or blood clots may occur during surgery or procedures.
